July 3. Haematuria. Urine test. pH 9.0, SG 1.034, Protein +, Blood 3+, Crystals triple phosphate +, amorphous phosphate 3+ . No bladder stone palpated. I advised X-ray and S/D for 3 months.
July 10. Cannot pee. Owner sent the dog for X-rays at another practice. No stones seen.
Aug 13. The owner brought in the urine for test. pH 8, SG 1.020, Blood Trace, Bacteria +, amorphous phosphate 2+, Triple phosphate occasional
After July 10, no problems of urination or visible blood in the urine and so the owners were satisfied. Surprisingly, the wife brought in the urine sample on Aug 13, for analysis as advised by me. Most Singaporean dog owners don't bother since the dog had no urination problems.
Dissolving of urinary crystals
My advice on the first consultation. S/D 3 months to dissolve the crystals. Urine test monthly. Then C/D dry.
PROBLEM
Dog will not eat the S/D and so the owner did not comply with my instructions. I advised the owner to feed 10% S/D and then add to become 100%. However, the owner bought S/D x 7 cans on Jul 6, 12 cans on Jul 20 and now 12 cans on Aug 13.
No dog treats given. Fed Pedigree Canned + rice in the past month.
CONCLUSION
The dog had no episodes of urination difficulty since Jul 10 to date. However, the mixture of S/D diet and other food did not dissolve the crystals as the owner needs to convert to 100% of S/D. I text the husband who says he will do it.
Aug 15, 2013. The husband phoned to see me in 20 minutes. I advised medication and review of the X-rays taken by another vet again. Many cases need monitoring and review but vets will have no "work-life" balance if they really review ever case and write case report to understand the effects of home management on S/D diet. So, we can't do it for every case.
In this case, S/D diet would have worked to eliminate the amorphous phosphate crystals in the urine if the owner had diligently converted the dog to 100% of S/D in July. Although the dog did not get 100%, she still benefited in that she no longer had urination problem.
But the latest urine test in Aug showed that blood, bacteria and crystals are coming back in the alkaline urine again.
Many owners don't understand the technical use of S/D diets in dissolving the crystals by acidification of the urine. So they don't comply since the dog will not eat it. The trick is to give 5% increasingly and consistently.
Let's hope this dog will be OK with the new motivation and participation of the owners, a couple in their late 50S
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Sunday, August 18, 2013
Dysuria - X-rays taken. S/D trials not properly complied with
"Practising heartlander medicine is not as easy as practising in a practice where clients do not worry about medical costs," I said to the two Raffles Institution interns from Secondary Four working on Aug 19, 2013. "Some owners don't want x-rays. Some don't want blood test and so the vet has no complete evidence to support his diagnosis and treatment.
Then the dog could not pee normally 7 days later. The owners phoned me. They went to a clinic to get the X-rays done and consulted me with the X-rays. There were no radio-dense stones.
I had
advised S/D
diet to
acidify the
urine which
had
amorphous
phosphate
urinary
crystals,
bacteria,
blood and
alkaline pH
3 days ago
during the
first
consult. I
also advised
S/D based on
urine test
and get
another
urine test 1
month later.
"My dog will
not eat the
S/D" the
couple said.
"Mix with
the original
food and
increase to
100% S/D," I
advised.
"Otherwise
the stones
may form."
One month
later, the
wife brought
in a bottle
of dog's
urine for
testing. The
amorphous
phosphate
crystals
were lesser
in amount
but a bit of
blood and
bacteria
were
present.
"You didn't
feed 100%
S/D for the
last 4
weeks. Based
on the
latest test,
the blood is
coming back
in the
urine."
This time
the couple
was serious.
"How did you
do it?" I
asked.
"Just starve
the dog. He
will eat
100% S/D".
S/D is fed
to dissolve
the
phosphate
crystals for
1-3 months.
Urine tests
must be done
monthly.
Then the
owner has to
be careful
in feeding
commercial
food. No
more dog
treats for
sure.